Provider Demographics
NPI:1467877464
Name:CLOVE COACH LLC
Entity Type:Organization
Organization Name:CLOVE COACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-497-7777
Mailing Address - Street 1:259 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4765
Mailing Address - Country:US
Mailing Address - Phone:845-497-7777
Mailing Address - Fax:845-497-7696
Practice Address - Street 1:163 BROOKSIDE FARMS RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3938
Practice Address - Country:US
Practice Address - Phone:845-497-7777
Practice Address - Fax:845-497-7696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03083667Medicaid